辅助技术在治疗白内障合并角膜混浊手术中的应用

目的：评价在白内障手术中应用包括囊膜染色、虹膜拉钩、虹膜切除等辅助技术治疗白内障合并角膜混浊患眼的术后视觉效果,并分析手术安全性和有效性。

方法：回顾收集2014-01/2019-03在新疆军区总医院全军眼科中心接受白内障超声乳化合并人工晶状体植入术的白内障合并角膜混浊患者105例105眼,所有患者接受白内障超声乳化摘除并人工晶状体植入术。术中应用台盼蓝囊膜染色剂,并观察前囊膜染色情况,连续环形撕囊成功率,晶状体后囊破裂及人工晶状体囊袋内植入情况。并于术后1d,1wk,1、3mo对患者进行随访,观察术中撕囊成功率,术前、术后的最佳矫正视力(BCVA,LogMAR),术后并发症等。

结果：患者均接受白内障超声乳化吸除合并人工晶状体植入术。术中通过应用台盼蓝囊膜染色剂(台盼蓝)染色前囊膜辅助成功完成所有连续环形撕囊,并采取了包括应用虹膜拉钩及虹膜切开术等其他措施。将可折叠式人工晶状体植入105眼。术后追踪观察3mo,术眼术后BCVA为0.82±0.10,与术前BCVA(3.12±0.14)比较有差异(t=174.893,P<0.01)。

结论：白内障超声乳化摘除术能使白内障合并角膜混浊患者的视力得到安全有效的提高。辅助技术如囊膜染色、虹膜拉钩、虹膜切除等的应用,能有效降低白内障合并角膜混浊患者的白内障手术风险,提高手术安全性,增加手术成功率。     

Trypan-blue- and endoillumination-assisted phacoemulsification in eyes with vitreous hemorrhage during combined cataract and vitreous surgery

PURPOSE: To study the safety and usefulness of trypan blue application and conventional endoillumination for enhancing visualization during phacoemulsification and foldable intraocular lens implantation in cases of cataract with vitreous hemorrhage. METHODS: Ten eyes of 10 patients with cataract and coexisting vitreous hemorrhage underwent combined trypan-blue- and endoillumination-assisted phacoemulsification and foldable intraocular lens implantation with vitrectomy. In a two-step surgery, after staining the anterior capsule with trypan blue, continuous circular capsulorhexis was performed; then, phacoemulsification was performed using conventional endoillumination. Specular microscopy was performed before and 3 months after surgery on eyes that underwent trypan-blue- and endoillumination-assisted phacoemulsification and on control eyes that underwent standard phacoemulsification to evaluate the toxic effect of trypan blue on corneal endothelial cells. RESULTS: Trypan blue application improved visualization of the anterior capsule, and a complete capsulorhexis could be performed in all eyes. In all 10 eyes, endoillumination was required to visualize the lens structure, and phacoemulsification could be accomplished. Specular microscopy revealed that there was no significant difference in the level of corneal endothelial cell loss between the trypan-blue- and endoillumination-assisted phacoemulsification group and the control group. CONCLUSION: The described double visualization technique may assist phacoemulsification in selected cases of cataract with vitreous hemorrhage.     

Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts

Aim: To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS: 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS: Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS: A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.     

Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study

PURPOSE: To compare the safety and efficacy of trypan blue 0.1%, gentian violet 0.001%, indocyanine green 0.5% (ICG), fluorescein 2%, and the patient's autologous blood for anterior capsule staining in cases of white cataract. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: Fifty eyes of 50 patients with age-related white cataract had anterior capsule staining with trypan blue, ICG, or gentian violet under an air bubble or subcapsularly with fluorescein or autologous blood followed by phacoemulsification with foldable intraocular lens implantation. Each stain was used in 10 eyes. The ease of creating a continuous curvilinear capsulorhexis (CCC) and the complications during the surgery were noted. Postoperative examinations at 6 hours, 1 day, 1 week, and 1 month included slitlamp microscopy, uncorrected visual acuity, and best corrected visual acuity (BCVA). The staining patterns on the anterior capsule, side port, corneal tunnel, and anterior cortex were assessed intraoperatively and within 6 hours and at 1 day. The intraocular pressure (IOP) was assessed at 1 day; pachymetry, at 1 day and 1 month; and the endothelial cell count, at 1 month. RESULTS: The surgeon had best visualization during the anterior capsulorhexis with trypan blue, ICG, and gentian violet, and a complete CCC was achieved in all eyes in the 3 groups. Two eyes each in the fluorescein and autologous blood groups had extension of the CCC so that the capsulorhexis was complete but not curvilinear. Anterior capsule fibrosis was detected with trypan blue (1 eye) and ICG (2 eyes). The anterior vitreous was stained with fluorescein in 2 eyes. All eyes achieved a BCVA of 20/30 or better from 1 week postoperatively to the last follow-up. The side port and corneal tunnel were stained most intensely with gentian violet followed by trypan blue and ICG and less intensely with fluorescein and autologous blood. The IOP, pachymetry, and endothelial cell loss were comparable between the stains. CONCLUSION: Although trypan blue, ICG, gentian violet, fluorescein, and autologous blood were safely used to stain the anterior capsule for phacoemulsification in eyes with white cataract, trypan blue, ICG, and gentian violet were more effective in staining the capsule.     

Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract

PURPOSE: To assess the feasibility, risks, and postoperative outcomes of phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorhexis (CCC) in the absence of a red reflex. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 52 eyes of 52 patients with white cataract that had phacoemulsification through a clear corneal temporal incision with PC IOL implantation. In all the cases, trypan blue was used under air to stain the anterior lens capsule and the karate-chop technique was used to emulsify the nucleus. The mean follow-up was 192.2 days. RESULTS: Trypan blue adequately stained the anterior lens capsule in all cases. The CCC was completed uneventfully in 96.15% eyes; 3.85% of cases had to be converted to a conventional extraction technique because of the loss of the CCC. The mean phacoemulsification time was 2.2 minutes. Intraocular complications included incomplete capsulorhexis (3.85%) and pupillary miosis (3.80%). Postoperatively, 3 eyes (5.77%) had corneal edema (striate keratopathy) and 1 eye (1.9%) had fibrin in the anterior chamber. Five eyes (9.61%) had more than 2+ cells and flare at 2 weeks. All responded well to intensive topical and subconjunctival steroids. There were no cases of endophthalmitis. The mean central endothelial cell loss, measured in 37 eyes, was 8.5%. Of the 4 eyes (7.69%) that had increased intraocular pressure (IOP) postoperatively, all responded well to medications and the IOP was normal by the second postoperative week. Fifty eyes (96.16%) had a final best corrected visual acuity of 20/30 or better. In 2 cases, the final visual acuity was worse than 20/200 because of preexisting posterior segment pathology. CONCLUSION: Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.     

小瞳孔白内障的超声乳化及折叠式人工晶状体植入术

目的探讨小瞳孔白内障的超声乳化及折叠式人工晶状体的手术技巧和临床效果。方法临床确诊的小瞳孔白内障患者46例54眼,经透明角膜隧道切口,采用钝性分离的方法扩大瞳孔,行环行撕囊、双手原位超声乳化及折叠式人工晶体囊袋内植入手术。结果术后随访5～12月,术后视力提高46眼占85.19%,视力≥0.5者34眼占62.96%,所有患者的瞳孔保持生理性圆形或是近圆形。手术并发症主要有角膜水肿、前房纤维素性渗出、后囊破裂。结论掌握合理的手术技巧,小瞳孔白内障的超声乳化术同样可以取得良好的手术效果。     

透明角膜切口超声乳化折叠人工晶状体植入术138例分析

目的 探讨透明角膜小切口白内障超声乳化及折叠式人工体植入术的方法及疗效。方法 对１３８例（１６８只眼）白内障病人进行透明角膜切口的超声乳化白内障摘出术,全部病 列均采用表面麻醉及植入折叠式人工晶状体,术后观察手术反应、视力和并发症。结果随访第１天的;裸眼视力在０．４以上者有１５７眼,占９３．４５％,术后１周和手术后１个月的矫正视力在０．５以上者分别为１５２眼（９０．４８％）和１６０眼（９５．４     

透明角膜切口白内障超声乳化摘除术临床观察

目的:探讨白内障超声乳化摘除联合注入式折叠人工晶状体植入术的效果。方法:对382例475眼行透明角膜切口白内障超声乳化摘除联合注入式折叠人工晶状体植入术的术后视力、并发症及安全性进行研究。结果:患者382例475眼手术顺利,术后1mo视力<0.3者10眼,均为眼底病变,视力未提高,>0.3者56眼,视力>0.5者409眼。患者满意,未出现严重眼部及全身并发症。结论:超声乳化白内障摘除联合注入式折叠人工晶状体植入术,术后视力恢复快,是治疗白内障安全有效的手术方法。     

超声乳化治疗白内障合并闭角型青光眼的临床体会

目的：观察超声乳化白内障摘除折叠人工晶状体植入术治疗白内障合并闭角型青光眼的临床效果。 方法：对29例29眼闭角型青光眼合并有白内障的患者行超声乳化白内障摘除折叠人工晶状体植入术,并对术后视力、眼压、前房角镜检查及并发症进行统计分析。 结果：患者28眼（96.5%）术后视力提高。25眼（86.2%）不需要用任何降眼压药物,眼压均维持在正常水平,3眼（10.3%）局部应用抗青光眼眼药水眼压控制正常,1眼（3.5%）行小梁切除术后眼压恢复正常。29眼房角镜检查房角较术前增宽。8例（27.6%）术后早期出现轻度角膜水肿,经治疗恢复正常。 结论：对合并白内障的原发性闭角型青光眼,术前房角粘连关闭≤270°者,可以考虑先行白内障超声乳化联合折叠人工晶状体植入术,可有效降低眼压,开放房角,提高视力,治疗效果良好。     

电子撕囊针在白色白内障手术中的应用

目的　评估电子撕囊针在白色白内障手术中应用的安全性和有效性。方法　３０例（３０眼）白色白内障患者随机分为常规撕囊组和电子撕囊组,各１５眼,均行白内障超声乳化联合人工晶状体植入术。常规撕囊组用传统撕囊镊撕囊,电子撕囊组用电子撕囊针撕囊。观察两组撕囊状况及人工晶状体植入情况。结果　两组所有患者均顺利完成白内障超声乳化联合人工晶状体植入术。除常规撕囊组１眼行人工晶状体睫状沟植入外,其余患者均囊袋内植入。常规撕囊组撕囊优良率只有２０％,失败率达６０％,而电子撕囊组撕囊优良率达１００％,两组差异有统计学意义（χ２＝１４．５２,Ｐ＜０．０１）。术后１周２组矫正视力和角膜内皮细胞计数差异均无统计学意义（均为Ｐ＞０．０５）。结论　白色白内障超声乳化术中使用电子撕囊针撕囊安全有效。     

非染色连续环形撕囊在白色白内障超声乳化中的应用观察

目的:探讨非染色连续环形撕囊超声乳化联合人工晶状体植入术治疗白色白内障的疗效。方法:对458眼白色白内障施行非染色连续环形撕囊超声乳化联合人工晶状体植入术,观察其撕囊成功率、术中的并发症、术后视力、术后角膜水肿反应等指标。结果:患者458眼中撕囊成功441眼(96.3%),17眼(3.7%)囊膜出现放射状撕裂,以剪刀剪出一囊膜瓣再完成撕囊。术中后囊膜破裂9眼(2.0%),术后轻度角膜水肿94眼(20.5%),中度水肿29眼(6.3%),重度水肿8眼(1.7%),水肿均在2～10d内消退,无角膜内皮失代偿。术后第1d视力均有明显的提高,视力>0.3者329眼(71.8%),术后1wk视力>0.5者417眼(91.0%)。结论:非染色连续环形撕囊超声乳化联合人工晶状体植入术治疗白色白内障虽手术操作较为困难,但熟练后成功率较高,术后视力恢复良好。     

穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入手术

目的探讨穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入方法及疗效。方法应用超声乳化仪为22只眼穿透性角膜移植术后白内障行白内障吸出和人工晶体植入手术。术后观察视力、角膜内皮变化和角膜移植片透明度。结果视力：12只眼0．1～0．4（54．5％），8只眼0．5～0.9（364％），2只眼＜01（9．1％）；角膜内皮细胞平均损失率17．76％；术后角膜移植片全部透明。结论本方法治疗角膜移植术后白内障，其术后视力恢复快，角膜内皮细胞损失少，可维持角膜移植片的透明。     

台盼蓝囊膜染色剂在复明工程成熟期白内障手术撕囊中的应用

目的 探讨台盼蓝囊膜染色剂在白内障复明工程白内障手术撕囊中的应用价值。设计 回顾性比较性病例系列。研究对象 2012-2013年期间河北省兴隆县人民医院“百万贫困白内障患者复明工程” 成熟期或过熟期白内障手术患者84例（84眼）。方法 随机分为观察组和对照组,每组42例（42眼）。观察组超声乳化白内障手术过程中接受0.1 ml 0.1%台盼蓝磷酸盐缓冲溶液前囊膜染色后行连续环形撕囊,对照组超声乳化白内障术中撕囊前未予染色。主要指标  术中囊膜染色情况,撕囊成功率,术后视力、眼压、前房炎症反应、角膜水肿及后囊混浊情况。结果 观察组台盼蓝染色后,晶状体前囊膜100%被染成淡蓝色。撕囊成功率观察组97.6%,对照组78.6%（P=0.003）;术后1个月视力、眼压、前房炎症反应、角膜水肿情况两组比较差异无统计学意义（均为P>0.05）;术后3个月后囊膜明显混浊观察组1/42例、对照组6/42例（P=0.027）。结论 白内障复明工程成熟期或过熟期白内障手术中采取台盼蓝囊膜染色剂行前囊膜染色,使连续环形撕囊相对容易,保证手术更顺利进行。（眼科,2014,23：271-273）     

Staining the Anterior Capsule with Indocyanine Green or Trypan Blue for Capsulorhexis in Eyes with White Cataract

Aim: To assess the efficacy and safety of indocyanine green (ICG) 0.5% and trypan blue 0.1% for anterior capsule staining in cases of white cataract. Methods: This prospective study comprised 55 eyes of 55 patients with white cataract that had phacoemulsification with foldable intraocular lens implantation. ICG in 30 eyes and trypan blue in 25 eyes were used under air to stain the anterior lens capsule. The staining patterns and the ease of creating a continuous curvilinear capsulorhexis (CCC) were assessed; the intraoperative and postoperative complications were noted. The mean follow-up was 17.68±1.65 months. Result: Either ICG or trypan blue stained the anterior capsule uniformly. However, the staining provided by trypan blue was slightly superior. A CCC was successfully achieved in 25 eyes (100%) with trypan blue, and 29 eyes (96.7%) with ICG, respectively. There was no significant postoperative reaction in any eye. Conclusion: The use of vital dyes such as ICG and trypan blue guarantees a complete CCC and makes it possible to deliver the benefits of phacoemulsification in the patients with white cataract.     

后极性白内障超声乳化吸除及折叠型人工晶状体植入术的临床观察

目的：探讨小切口超声乳化治疗后极性白内障的手术技术以及术中、术后并发症的处理方法。方法：46例患者(61只眼)，年龄38-78岁，平均57岁。在表麻下行颈侧透明角膜隧道切口的超声乳化，并对后囊下混浊斑块行剥离吸除、环形撕后囊或剪除混浊的后囊及折叠型人工晶状体植入术。结果：51只眼后囊膜完整，其中6只眼有后囊膜混浊；在10只后囊膜破裂眼中，4只眼有玻璃体脱出需行前段玻璃体切割术，并有1只眼晶状体皮质软壳沉入玻璃体腔引起葡萄膜炎及继发性青光眼需再次行后段玻璃体切割。58只眼人工晶状体囊袋内固定，3只眼睫状沟固定。结论：对后极性白内障行超声乳化手术时，谨慎处理后囊下混浊斑块，可以减少术中、术后的并发症，明显提高患者的术后视力。眼科学报2003；19：92-94     

青光眼合并白内障超声乳化人工晶状体植入联合小梁切除术的效果

目的探讨青光眼合并白内障行超声乳化吸出、人工晶状体植入联合小梁切除术的效果。方法青光眼合并白内障44例（47眼）,行超声乳化吸出及折叠式人工晶体植入联合全巩膜隧道内小梁切除术,术后观察眼压、视力、滤过情况等,随访1～36个月。结果47眼术后眼压均可控制在正常范围,长期随访眼压未升高,术后矫正视力：数指2眼（4．26％）,0．1～0．633眼（70．21％）,0．8-1．212眼（25．53％）,术后并发症主要是虹膜反应、角膜水肿及瞳孔散大。结论白内障行超声乳化及折叠式人工晶状体植入联合巩膜隧道内小梁切除术可有效控制眼压,提高视力。     

Cystinosis, cataract surgery, and corneal erosions

A 21-year-old man presented with severe corneal cystinosis and steroid-related cataract bilaterally. Rather than combined cataract surgery and penetrating keratoplasty, the patient had uneventful phacoemulsification and intraocular lens implantation after which visual acuity improved to 66 in both eyes. The outcome indicates that conventional phacoemulsification is sufficient in these cases. A guarded prognosis is advised in patients with cystinosis having cataract surgery as the fundal view is often impaired and there may be associated maculopathy.     

飞秒激光辅助的穿透性角膜移植联合手法碎核白内障摘除人工晶状体植入术

目的：探讨同时行飞秒激光辅助的穿透性角膜移植术（ PKP）及小切口手法碎核白内障摘除联合人工晶状体植入术治疗同时患有白内障及角膜病患者的适应证、手术技巧及术后疗效。方法应用飞秒激光辅助的PKP联合小切口手法碎核白内障摘除人工晶状体植入术治疗同时患有白内障及角膜病的患者6例（6只眼）,观察其术后裸眼视力、最佳矫正视力、眼压、植片、人工晶状体情况及前房反应。随访9个月。结果治疗后6例术后裸眼视力均比术前有不同程度的提高,术后9个月裸眼视力≥0．3者4例,0．2者2例;5例最佳矫正视力≥0．5,1例最佳矫正视力为0．4。术后7～14 d,5例角膜植片全透明,1例角膜植片轻度水肿。至术后9个月,6例角膜植片全透明;6例术后眼压均正常,人工晶状体位置正,位于囊袋内。结论飞秒激光辅助的PKP联合小切口手法碎核白内障摘除人工晶状体植入术对眼球损伤更小、手术效果更确切、治疗病程更短,可以一次性解决眼前段的屈光间质混浊。与传统分期手术相比减少了术后并发症,使患者快速恢复术后视力,安全性较高。     

Simultaneous penetrating keratoplasty, cataract extraction and artificial lens implantation ("triple procedure") 1981-1987

Between June 1981 and March 1987, the authors performed simultaneous penetrating keratoplasty, cataract extraction, and intraocular lens implantation in 90 eyes. The main indications were Fuchs's corneal endothelial dystrophy (38 cases), corneal cicatrization (33 cases) and corneal or scleral perforation (7 cases). Extracapsular cataract extraction with posterior chamber lens implantation was performed in 82 patients. The posterior capsule ruptured in nine eyes, necessitating an anterior vitrectomy in four of them. The corneal transplant was rejected in nine eyes (10%). The mean preoperative visual acuity of 9/100 in 89 patients improved to 39/100 six months after surgery in 59 patients who were followed up and to 50/100 in the 29 patients with Fuchs's corneal dystrophy. The authors believe that in cases presenting with both cataract and medically uncontrollable corneal disease, simultaneous penetrating keratoplasty with extracapsular cataract extraction and implantation of a posterior chamber lens represents the treatment of choice.     

Cataract surgery with implantation of toric silicone lenses for severe astigmatism after keratoplasty

BACKGROUND: The treatment of high astigmatism after keratoplasty is often not possible with glasses or refractive corneal surgery, particularly in patients with anisometropia and contact lens incompatibility. METHODS: In 3 patients with cataract and high astigmatism after penetrating keratoplasty, phacoemulsification was performed via a 4 mm sclerocorneal tunnel incision. A toric silicone lens with Z-haptic was implanted in the bag (Type MS 6116 TU, Dr. Schmidt). All patients had high anisometropia and contact lens incompatibility. The follow-up was ten weeks, uncorrected and corrected visual acuity, corneal and total astigmatism were evaluated. RESULTS: A 68-year-old female presented with corneal astigmatism of 10 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 22.5 + 11.0 dpt.) uncorrected visual acuity increased from 1/50 to 20/40, corrected visual acuity increased from 20/30 to 20/25. A 78-year-old male presented with irregular corneal astigmatism of 6.5 dpt. Keratoplasty was performed 25 years previously. Due to high myopia (corneal radii 5.3/5.9 mm), implantation of a toric lens (- 3.0 + 7.0 dpt.) in the bag was combined with implantation of a spheric lens (- 6.0 dpt., Type MS 614, Dr. Schmidt) in the sulcus. Uncorrected visual acuity increased from light perception to 1/20, corrected visual acuity increased to 1/10. An 84-year-old female presented with irregular corneal astigmatism of 8.6 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 16.0 + 11.0 dpt.) uncorrected visual acuity increased to 20/50, corrected visual acuity increased from 20/100 to 20/25. During the follow-up all implanted lenses were well-centered and no significant IOL rotation was observed. CONCLUSION: Implantation of foldable toric silicone lenses during cataract surgery may improve considerably the uncorrected visual acuity by reducing the total astigmatism in patients with high astigmatism after keratoplasty. Preoperatively, a reliable keratometry is important.